Knee Surgery and Related Research最新文献

{"title":"Long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy in 274 knees: a Kellgren-Lawrence grade-stratified analysis.","authors":"Noriyuki Gomi, Nobuhiro Chikaishi, Ryuichi Isozaki","doi":"10.1186/s43019-026-00351-3","DOIUrl":"https://doi.org/10.1186/s43019-026-00351-3","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to investigate long-term outcomes and factors associated with revision after medial open-wedge high tibial osteotomy (OWHTO) according to Kellgren-Lawrence (KL) grade.</p><p><strong>Methods: </strong>This retrospective study included 274 knees (158 KL grade 4 [KL4] knees and 116 KL grades 2-3 [KL2-3] knees; mean age 64.7 ± 7.2 years) with a minimum follow-up of 10 years (mean follow-up, 12.5 ± 2.6 years) after OWHTO. Revision surgery (conversion to total knee arthroplasty [TKA] or unicompartmental knee arthroplasty [UKA]) was defined as the endpoint. Clinical and radiographic outcomes were evaluated. Multivariate logistic regression analyses were performed separately for KL4 and KL2-3 knees to identify factors associated with revision.</p><p><strong>Results: </strong>The mean Japanese Orthopaedic Association (JOA) score improved from 60.6 preoperatively to 91.0 at plate removal, followed by gradual deterioration during long-term follow-up. Final JOA scores were significantly lower in KL4 knees than in KL2-3 knees (71.6 versus 83.1; p < 0.001). Revision surgery was performed in 43 knees (15.7%) and was significantly more frequent in KL4 than in KL2-3 knees (22.2% versus 6.9%; p < 0.01). Ten-year joint preservation rates were 90.5% in KL4 knees and 96.5% in KL2-3 knees (log-rank p = 0.006). In KL4 knees, postoperative percentage mechanical axis (%MA) at the time of plate removal was independently associated with revision risk (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.91-0.98; p = 0.004). In KL2-3 knees, an exploratory multivariate analysis suggested an association between progression of joint line convergence angle during follow-up (ΔJLCA) and revision (OR 3.31, 95% CI 1.52-7.21; p = 0.003), whereas postoperative %MA showed no significant association.</p><p><strong>Conclusions: </strong>Long-term outcomes after OWHTO differed according to KL grade. KL4 knees demonstrated higher revision rates and inferior joint preservation survival, and postoperative weight-bearing line position was associated with revision risk. In contrast, revision was uncommon in KL2-3 knees, and exploratory analysis suggested a possible association with longitudinal changes in joint line convergence rather than postoperative alignment. These findings suggest that factors associated with revision may differ according to disease severity.</p><p><strong>Level of evidence: </strong>This was a level IV, retrospective cohort study.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic factors associated with outcomes after knee cartilage repair across different procedure types: a systematic review.","authors":"Joo Hyung Han, Min Jung, Kwangho Chung, Hyun-Soo Moon, Se-Han Jung, Seung Hoon Baik, Jeongmo Koo, Sung-Hwan Kim","doi":"10.1186/s43019-026-00350-4","DOIUrl":"https://doi.org/10.1186/s43019-026-00350-4","url":null,"abstract":"<p><strong>Purpose: </strong>To identify and describe the prognostic factors associated with outcomes after knee cartilage repair within distinct procedure and disease contexts.</p><p><strong>Methods: </strong>PubMed, Embase, the Cochrane Library, and Google Scholar were searched from inception to 29 August 2026; backward and forward citation searching was also performed. Eligible reports quantitatively evaluated baseline factor-postoperative outcome associations after knee cartilage repair. Two reviewers independently selected reports, extracted association-level data, and applied the quality in prognosis studies tool. Because effect measures could not be harmonized, findings were synthesized without meta-analysis by disease context, procedure, factor, outcome, and follow-up.</p><p><strong>Results: </strong>Thirty-one reports were included, with report-level sample sizes totaling 13,022; cohort overlap prevented determination of the number of unique participants. Of 37 study-analysis units, 29 were at high risk-of-bias and 8 at moderate risk; none were at low risk. In isolated marrow stimulation, increasing age was associated with less favorable short- and long-term outcomes in two multivariable analyses at high overall risk-of-bias, whereas lesion-size findings varied across outcomes and follow-up. Autologous chondrocyte implantation (ACI)/matrix-induced autologous chondrocyte implantation (MACI) studies reported outcome-specific associations involving age, sex, body mass index, baseline status, defect characteristics, previous surgery, and manufacturing variables. Adjusted osteochondral-allograft failure analyses identified age, body mass index, diagnosis, graft area, and bony realignment as candidate factors; clinical-threshold and machine-learning findings remained context dependent. In osteoarthritis-associated cell-based cohorts, older age and bipolar lesions were associated with long-term failure in one adjusted analysis, while other findings were imprecise or derived from overlapping cohorts. No factor was consistently established across procedures or outcomes. A formal certainty-of-evidence framework was not applied because of marked heterogeneity, sparse context-specific evidence, and generally high risk-of-bias; definitive between-procedure comparisons were not possible.</p><p><strong>Conclusions: </strong>Available evidence identifies candidate prognostic associations within specific disease, procedure, outcome, and follow-up contexts. However, substantial clinical heterogeneity, potential confounding, cohort overlap, and sparse context-specific evidence limit the certainty and generalizability of the findings. The evidence does not support universal clinical cutoffs or conclusions that prognostic effects differ between procedures.</p><p><strong>Level of evidence: </strong>level IV, systematic review of level I-IV studies.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jumping patella is associated with inferior clinical outcomes after MPFL reconstruction for recurrent patellar dislocation: a retrospective cohort study.","authors":"Daofeng Wang, Yang Liu, Zhengjie Tang, Zhijun Zhang, Hui Zhang","doi":"10.1186/s43019-026-00347-z","DOIUrl":"10.1186/s43019-026-00347-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;To date, two studies have established the correlation between jumping sign and multiple bony abnormalities. However, no studies have yet reported the association between the jumping sign and clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;(1) To determine the bony risk factors of jumping patella and (2) to compare clinical outcomes between jumping and gliding patellae following medial patellofemoral ligament (MPFL) reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;Between 2018 and 2022, 85 patients with recurrent patellar dislocation (RPD) who underwent MPFL reconstruction were retrospectively reviewed. Patients were stratified into two groups based on the presence or absence of the preoperative patellar jumping sign. Standard hip-knee-ankle computed tomography (CT) scans were obtained for all patients, through which lower limb torsional deformities and bony morphology were evaluated. Bony risk factors for preoperative jumping patella were identified using logistic regression analysis. Clinical outcomes were compared between groups at final follow-up. Subgroup analyses were conducted to examine outcome differences between surgical procedures within each patellar tracking group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study included a total of 85 patients, with 36 cases in the jumping group. Multivariate regression analysis identified knee torsion (odds ratio [OR] = 7.16, 95% confidence interval [CI] = 1.64-31.33, P = 0.009) and supratrochlear bump (OR = 30.5, 95% CI = 6.95-133.77, P &lt; 0.001) as significant factors associated with jumping patella. At the final follow-up, the jumping group demonstrated significantly lower Lysholm (75.7 versus 86.1, P = 0.002) and Kujala (80.8 versus 89.9, P = 0.003) scores compared with the gliding group. The jumping group showed significantly greater patellar medial laxity index (38% versus 22%, P = 0.001), and higher rates of residual maltracking (55.6% versus 16.3%, P &lt; 0.001), jumping patella (27.8% versus 2%, P &lt; 0.001), MPFL graft laxity (22.2% versus 4.1%, P = 0.01), and patellar redislocation (13.9% versus 2%, P = 0.035), compared with the gliding group. The subgroup analysis revealed that in cases of MPFL reconstruction combined with tibial tubercle transfer, the jumping patella had a much higher incidence of residual patellar maltracking (54.5% versus 15.6%, P = 0.005) and positive jumping sign (27.3% versus 0%, P = 0.002), compared with the gliding group, while no significant differences were found between the two groups in patient-reported outcome measures (PROMs), MPFL graft laxity, and patellar redislocation (all P &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Compared with the gliding patella, the jumping patella undergoing isolated MPFL reconstruction exhibited worse clinical outcomes. Although the combined procedure improved knee function and reduced redislocation rates to some extent, it could not significantly correct the persistent maltracking or jumping","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term changes in playing time, competitive level, and market value after ACL reconstruction in elite Spanish professional football players.","authors":"Verónica Montiel, Hugo Álvarez García, Natalia Alejandra Ramirez, Nerea Mateo, Andrés Valentí","doi":"10.1186/s43019-026-00346-0","DOIUrl":"10.1186/s43019-026-00346-0","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate the epidemiology and longitudinal postinjury changes in playing time, competitive level, and market value in professional male football players from Spain's First Division following anterior cruciate ligament reconstruction.</p><p><strong>Methods: </strong>This retrospective cohort study included 132 anterior cruciate ligament injuries in 115 professional football players identified between the 2010-2011 and 2023-2024 seasons using public databases (Transfermarkt and BeSoccer), with cross-validation against official medical reports or news sources. Return to play, league level, minutes played, and market value were tracked up to 5 years postinjury. Statistical analyses included chi-squared tests, repeated-measures analysis of variance (ANOVA), mixed-effects models with Dunnett-adjusted comparisons, Wilcoxon signed-rank testing, and exploratory multivariate regression analyses.</p><p><strong>Results: </strong>The mean age at injury was 26.7 years. The return to play rate was 97.7%, with a mean return to play time of approximately 9.1 months. The first competitive appearance occurred at a median of 13.5 days after the first matchday squad inclusion. However, 35.2% of players dropped at least one competitive league level by the first postinjury season, increasing to 61.3% by the fifth season. Minutes played decreased by 46% in the first postinjury season (p < 0.001), with only partial recovery thereafter. Minutes per match played remained approximately 21 min below preinjury values during both the first and second postoperative seasons (both p < 0.001). Market value declined significantly across follow-up, reaching up to a 47.7% reduction by year 5, particularly among players aged 30 years or older.</p><p><strong>Conclusions: </strong>Longitudinal reductions in playing time, competitive level, and market value were observed following ACL injury in professional football players, despite high return to play (RTP) rates. Reduced minutes per match played further indicated persistent limitations in competitive utilization during the first two postoperative seasons.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of single-radius total knee arthroplasty in an Asian population: a comparison of cruciate-retaining and posterior-stabilized designs.","authors":"Gi-Young Jang, Hyobeom Lee, Kang-Il Kim","doi":"10.1186/s43019-026-00349-x","DOIUrl":"10.1186/s43019-026-00349-x","url":null,"abstract":"<p><strong>Background: </strong>Single-radius total knee arthroplasty (TKA) has demonstrated favorable clinical outcomes and survivorship; however, long-term comparative data between cruciate-retaining (CR) and posterior-stabilized (PS) designs within a single-radius system remain limited, particularly in Asian populations. This study aimed to evaluate the long-term clinical and radiologic outcomes and survivorship of single-radius TKA and to compare CR and PS designs in an Asian population.</p><p><strong>Methods: </strong>This retrospective study included 222 knees (152 patients) that underwent primary TKA using a single-radius prosthesis between 2006 and 2015, with a minimum follow-up of 10 years. There were 112 CR knees and 110 PS knees. Clinical outcomes were assessed using the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and Forgotten Joint Score. Radiologic outcomes were also evaluated. Kaplan-Meier survivorship analysis was performed using revision for all causes and aseptic revision as endpoints. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences between groups.</p><p><strong>Results: </strong>At a mean follow-up of 13.2 ± 2.8 years, significant improvements were observed in all clinical outcomes compared with preoperative values (all p < 0.001). At the final follow-up, clinical outcomes did not differ significantly between the CR and PS groups, and IPTW-adjusted analyses also showed no statistically significant between-group differences. Revision surgery was performed in 6 of 222 knees (2.7%), with no difference between groups (p = 0.44). In the overall cohort, the 15-year Kaplan-Meier survivorship free from revision for all causes was 96.2% (95% CI 93.2-99.4). The estimated 15-year aseptic revision-free survivorship was 98.9% (95% CI 96.9-100) in the CR group and 95.6% (95% CI 91.4-100) in the PS group. Survivorship did not differ significantly between the CR and PS groups for either all-cause or aseptic revision (log-rank p = 0.99 and p = 0.99, respectively). However, only six revision events occurred, limiting the statistical power to exclude a clinically meaningful between-group difference.</p><p><strong>Conclusions: </strong>Single-radius TKA demonstrated favorable long-term clinical outcomes and high survivorship in an Asian population. No significant between-group differences were identified in clinical outcomes or survivorship between the CR and PS groups.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of total joint arthroplasty in patients with a history of native hip or knee septic arthritis: a systematic review and meta-analysis.","authors":"Chang-Rack Lee, Dae-Hyun Park, Yong-Uk Kwon, Ji-Hun Park, Dong-Yun Lee","doi":"10.1186/s43019-026-00348-y","DOIUrl":"10.1186/s43019-026-00348-y","url":null,"abstract":"<p><strong>Background: </strong>Whether a history of native hip or knee septic arthritis is associated with an increased risk of periprosthetic joint infection (PJI), aseptic revision, or reoperation after total joint arthroplasty (TJA) remains unclear. This meta-analysis aimed to evaluate whether patients with a history of native hip or knee septic arthritis (septic arthritis group) are at higher risk of PJI, aseptic revision, and reoperation after primary TJA than those without (nonseptic arthritis group). We hypothesized that a history of septic arthritis is associated with an increased risk of complications after TJA.</p><p><strong>Methods: </strong>A systematic literature search of MEDLINE, Embase, and the Cochrane Library was conducted to identify studies comparing the outcomes of primary TJA between patients with a history of native hip or knee septic arthritis and those without. Previous studies reporting postoperative infection, aseptic revision, or reoperation rates were included in the analysis. The septic arthritis group comprised patients with sequelae of childhood joint infection and those who underwent one- or two-stage TJA for active or previously treated septic arthritis. Random-effects meta-analyses were performed to calculate pooled risk ratios with 95% confidence intervals.</p><p><strong>Results: </strong>This research included seven studies, comprising 5842 arthroplasties in the septic arthritis group (total hip arthroplasty [THA]: 1351; total knee arthroplasty [TKA]: 4491) and 10,589 arthroplasties in the nonseptic arthritis group (THA: 5299; TKA: 5290). Patients with a history of septic arthritis were at significantly higher risk of postoperative PJI than those without, with substantial heterogeneity. The risk of aseptic revision did not significantly differ between the septic arthritis and nonseptic arthritis groups. However, patients with a history of septic arthritis were at significantly higher risk of reoperation.</p><p><strong>Conclusions: </strong>Patients with a history of native hip or knee septic arthritis are at significantly higher risk of postoperative infection and reoperation after total joint arthroplasty compared with those without a history of joint infection. Surgeons should be aware of the increased risk of complications in this high-risk population. Nevertheless, further studies should be performed to determine the optimal timing of arthroplasty after septic arthritis and to identify strategies that can reduce postoperative complications.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VELYS robotic-assisted solution achieves more accurate bone cutting and neutral ground mechanical axis compared with an accelerometer-based portable navigation system in ground kinematically aligned total knee arthroplasty.","authors":"Tomoyuki Matsumoto, Masanori Tsubosaka, Naoki Nakano, Tomoyuki Kamenaga, Yuichi Kuroda, Shinya Hayashi, Ryosuke Kuroda","doi":"10.1186/s43019-026-00344-2","DOIUrl":"10.1186/s43019-026-00344-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to compare the accuracy of bone cutting, achievement of target alignment, and early clinical outcomes between ground kinematically aligned total knee arthroplasty (KA-TKA) performed using the VELYS^TM robotic-assisted solution (VRAS) and that performed using an accelerometer-based portable navigation system (APNS) in patients with varus osteoarthritis.</p><p><strong>Methods: </strong>This cohort study prospectively enrolled 35 consecutive patients who underwent ground KA-TKA using the VRAS and compared them with 35 consecutive patients treated with the same surgical procedure using the APNS. The primary end point was the accuracy of bone cutting and achievement of target alignment. Clinical outcomes were evaluated at 1 year postoperatively.</p><p><strong>Results: </strong>The VRAS group demonstrated significantly smaller mean absolute errors from target values, particularly in femoral bone cutting and achievement of a neutral ground mechanical axis, compared with the APNS group (0.7 ± 0.8° versus 1.5 ± 1.1°, 1.6 ± 1.8% versus 3.0 ± 2.4%, p < 0.05, respectively). There were no significant differences in range of motion and 2011 Knee Society Score between groups.</p><p><strong>Conclusions: </strong>Ground KA-TKA performed using the VRAS achieved higher accuracy in bone cutting and more reliable achievement of a neutral ground mechanical axis, compared with the APNS.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee valgus proprioception, muscle activity, patient-reported outcomes and dynamic balance control after anterior cruciate ligament reconstruction: a cross-sectional case-control study.","authors":"Mengde Lyu, Adrian Pranata, Joshua Farragher, Jinglei Huang, Huaibin Qian, Roger Adams, Weixin Zhang, Ji Sun, Qingrong Xu, Jia Han, Evangelos Pappas","doi":"10.1186/s43019-026-00341-5","DOIUrl":"https://doi.org/10.1186/s43019-026-00341-5","url":null,"abstract":"<p><strong>Background: </strong>Proprioceptive deficits following anterior cruciate ligament reconstruction (ACLR) are commonly assessed using sagittal-plane, nonweight-bearing tasks that may not reflect the demands of functional activities. This study evaluated the test-retest reliability and discriminative validity of a weight-bearing knee valgus discrimination task (Knee-VEDA) and compared proprioceptive acuity, muscle activity, dynamic balance, and patient-reported outcomes between individuals with ACLR and healthy controls.</p><p><strong>Methods: </strong>Sixty-three participants (32 ACLR, 31 controls) performed the Knee-VEDA with concurrent surface electromyography (sEMG) of seven lower-limb muscles. Test-retest reliability was assessed. Dynamic balance and patient-reported outcomes were evaluated using the Y-Balance Test, International Knee Documentation Committee (IKDC) form, and Knee injury and Osteoarthritis Outcome Score (KOOS).</p><p><strong>Results: </strong>The Knee-VEDA demonstrated acceptable-to-good test-retest reliability (ACLR ICC = 0.84; controls ICC = 0.64) and acceptable discriminative validity (AUC = 0.835, p < 0.001). The ACLR group exhibited significantly poorer proprioception in the operated limb compared with their intact limb and controls (p < 0.001). sEMG analysis revealed not statistically significant between-group differences in lower-limb muscle activity. ACLR participants also demonstrated inferior Y-Balance performance compared with controls (_p = 0.02). In the ACLR group, better Knee-VEDA scores correlated with better Y-Balance (_r = 0.50, p < 0.001), and better KOOS symptoms scores (_r = 0.55, _p = 0.001).</p><p><strong>Conclusions: </strong>The Knee-VEDA may be a useful tool for assessing weight-bearing knee proprioception after ACLR, showing acceptable test-retest reliability and discriminative validity. After ACL reconstruction, operated-limb proprioceptive acuity was found to be reduced during the valgus task. Further validation is needed before clinical application.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auditory-cued terminal knee extension enhances vastus medialis motor unit function in the early phase following ACL reconstruction: a randomized controlled trial.","authors":"Sakda Nitkotom, Pisit Lertwanich, Pongthanayos Kiratisin, Poramate Suntornon, Ainthira Sonsukong, Patitta Rangsiyanon, Apicha Tosapornsupaluck, Roongthiwa Vachalathiti, Kantheera Areerak, Tananthorn Piamthipmanas, Kornkit Chaijenkij, Komsak Sinsurin","doi":"10.1186/s43019-026-00343-3","DOIUrl":"https://doi.org/10.1186/s43019-026-00343-3","url":null,"abstract":"<p><strong>Background: </strong>Following anterior cruciate ligament reconstruction (ACLR), the vastus medialis (VM) commonly exhibits functional deficits largely attributed to neuromuscular alterations. This study aimed to investigate the immediate effects of terminal knee extension (TKE) exercise synchronized with auditory cues on VM motor unit behavior in individuals 2 weeks postACLR.</p><p><strong>Methods: </strong>The study recruited 38 individuals who underwent primary ACLR 2 weeks postsurgery and they were randomly assigned to experimental or control groups. The experimental group performed three sets of TKE exercises synchronized with auditory cues; the control group performed identical exercises without auditory cues. Before and after the intervention, VM muscle activity, motor unit action potential (MUAP), and motor unit firing rate (MUFR) were assessed during knee extension using a Trigno-Galileo electromyography system. Within and between-group differences were analyzed using parametric or nonparametric methods, as appropriate, on the basis of data distribution. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>Data from 20 participants (10 experimental, 10 control) were included in the final analysis. The auditory-cued group demonstrated significantly greater increases in peak [12.59 (IQR 17.89) µV, p = 0.043] and average [11.31 (IQR 3.04) µV, p = 0.029] MUAP compared with the noncued group [6.26 (IQR 11.02) µV and 2.24 (IQR 9.94) µV, respectively]. Moreover, only the auditory-cued group showed significant postintervention increases in average electromyography (EMG) activity [pre: 14.23 (IQR 11.37) µV; post: 17.60 (IQR 20.94) µV; p = 0.007], average MUAP [pre: 43.07 (IQR 34.30) µV; post: 50.33 (IQR 36.12) µV; p = 0.005], peak MUAP [pre: 55.54 (IQR 50.35) µV; post: 61.69 (IQR 52.92) µV; p = 0.005], and peak MUFR (pre: 10.50 ± 4.29 pps; post: 12.66 ± 3.36 pps; p = 0.016) after the intervention.</p><p><strong>Conclusions: </strong>A single session of TKE exercise synchronized with auditory cues significantly increased MUAP in the VM muscle in individuals 2 weeks post-ACLR. These findings likely reflect enhanced acute neural drive and improved VM motor unit recruitment. Auditory-cued TKE may represent a potential strategy to enhance neuromuscular control during the early postoperative phase. However, these effects reflect only immediate responses, and the persistence of these adaptations with longer-term training remains to be determined.</p><p><strong>Trial registration: </strong>NCT06662955 (25 October 2024, on ClinicalTrials.gov).</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Radiological risk factors in different patterns of patellar instability\".","authors":"Eşref Selçuk","doi":"10.1186/s43019-026-00324-6","DOIUrl":"10.1186/s43019-026-00324-6","url":null,"abstract":"<p><p>I read with great interest the recently published article by Chouhan et al. examining radiological risk factors across different patterns of patellar instability. The authors investigated trochlear dysplasia, tibial tubercle-trochlear groove (TT-TG) distance, and patellar height across single-episode, recurrent, and habitual patellar dislocation phenotypes. While this phenotype-based imaging approach addresses a clinically relevant question, several methodological and conceptual considerations may limit the robustness and clinical translatability of the reported between-group differences. The analysis was performed at the knee level despite inclusion of bilateral cases, without accounting for within-patient clustering, potentially inflating statistical significance. In addition, exclusion of patients who underwent stabilization procedures, particularly among single-episode dislocators, may introduce spectrum and selection bias, exaggerating apparent phenotype contrasts. The absence of formal inter- and intraobserver reliability assessment further constrains interpretation, especially given the known measurement variability of TT-TG distance, patellar height indices, and dysplasia grading. Reported TT-TG differences between single-episode and recurrent instability were small, with substantial overlap and without confidence intervals, reliability metrics, or threshold-based analyses, limiting clinical actionability within contemporary multifactorial decision frameworks. Inclusion of habitual patellar dislocation, often a developmental condition with distinct and entrenched structural abnormalities, within the same comparative construct as episodic instability raises concerns regarding construct validity and extrapolation of management implications. In conclusion, this work tackles an important clinical topic, and its conclusions could be further consolidated by incorporating cluster-aware analyses, clearly documenting exclusion patterns and reporting measurement reproducibility and TT-TG analyses aligned with clinically actionable thresholds within a multifactorial anatomical framework.</p>","PeriodicalId":36317,"journal":{"name":"Knee Surgery and Related Research","volume":"38 1","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}